question about confidentiality

How much does therapy confidentiality protect?

Does it mean only information that could be used to identify someone?

Scenario:

A client accidentally damaged something in the hall of a building where T office is. Client feels badly about this. T confronts Client about it in session, angrily, and client offers to pay damages to T, thinking that T would arrange repairs.

T then talks to building manager about the damages and notes that it was a client. T never mentioned to Client that T planned to have this conversation. Presumably, no identifying information about Client is revealed, but content of the session (that Client caused damages) was communicated to Building Manager. Building Manager and T agree on a "cost" for Client to pay. T communicates all of this to Client after the fact.

Client is upset because T did not consult Client before speaking to building manager. Client did not intend, when saying she would pay for damages, to involve a third party in conversation.



Does confidentiality extend to situations like this? Or, since the Building Manager doesn't know who, out of T's clients, caused damages is it OK?

I would say the client's confidentially is in tact there. The building manager doesn't know which client or why. As long as no identifying information was given it's not a breach.
But, it may have been helpful for the T to explain what s/he was planning to say, just to make the client aware. Also, if the client is upset by the turn of events, it would be useful to discuss that in therapy.

I agree with Echos Myron. As long as the therapist didn't give out a name confidentiality is intact.
Just a thought but maybe the therapist was trying to get the best price for the repair by saying it was for damage that a client would have to pay for. The manager might have charged more if they thought the therapist was going to pay for it.

I don't think confidentiality has been breached. I suppose given the personal nature of therapy, it could feel like it, but if you change therapist in the scenario for any other professional who is required to observe confidentiality - lawyer, doctor - it's just not a concern.

That said, the client should bring it up in therapy if it bothers them.

Just a follow up question:

What if it was something else? Like, the therapist mentioned at a dinner party to friends that a client damaged something in the hall? Or, a therapist mentioned to a stranger something from a client's session - that the client did something embarrassing, let's say.

As long as there's no name attached, the therapist is OK in discussing content from the client's session?

Would those be breaches? If so, what's the distinction?

I don't think it's just "no names." It's any identifying information at all. So in your original scenario, if the therapist had said "my Monday 2:30 appointment broke your vase" or whatever, that would be a breach. In your second scenario, I think it's very poor judgment to discuss clients outside of therapy (barring consultation with another professional authorized by the client), but I don't think it's technically a breach if names and identifying information are not included.

I guess what I'm getting at is does confidential mean that things will be kept anonymous or that things will be kept completely private, unless the client states otherwise.

What if the contract states something like: 'The law protects the privacy of all communications between a client and a psychologist. Our sessions will be completely confidential unless you sign a written consent to have information released.'

That refers to anything said in session (there are usually exceptions, like if you're threatening harm to yourself or others), or by email or phone. Those communications should be confidential.

Your initial scenario referred to events outside of session. In that scenario, so long as the therapist didn't identify you, it's not a breach. The question of identification there was not so much a concern over the damage as that no one should know you're in therapy, unless you want them to. It's why accidental public run-ins between therapists and clients can be messy: acknowledge the client and risk the client's privacy, or ignore them?

But again, discussion with the therapist in question seems like a good path forward.

Client will discuss with therapist.

The event outside the session (damage to vase) wouldn't have been brought to therapist attention without client disclosing vase-breaking act within session.

Thus, Client communicated the vase-breaking during the session, after confrontation by Therapist. Accidental vase-breaking was very distressing to client.

...

Regardless of whether or not it was talked about in session, T has not violated any confidentiality laws or ethics so long as T is not naming any specifics about this said client that would lead to giving this clients identity away. Sorry.

I have a question about confidentiality also. Since it is being discussed, I hope it is ok that I post here about it.

I think, as far as your question goes, if the therapist didn't give up a client's name, I don't think they betrayed confidentiality. If the therapist simply stated a client of theirs caused the damage, and paid for it, that's ok. Just my opinion.

My confidentiality question is about prescription drug abuse. I take it to feel better. no one knows. not even my therapist. I want to go off cold turkey, and on this med it is safe to do so. I would like to tell my therapist in my session this coming week. That I'm doing it and that I intend to stop. The therapist cannot share this with my family or my doctor, right? I know if I was doing it, attempting to overdose, they would have to. But that is not the case here.

Based on what do you make this assertion?

I suspect the conversation with the building manager was simply something like one of my clients let me know that she broke that vase accidentally. Let me know how we need to go about resolving the issue of replacing the vase. The manager said it would have to be paid for. Client broke it. T communicated cost of vase to client. Kind of end of discussion. I don't see any breach of confidentiality there.

Why not? "Client let me know that she broke the vase" - information provided by client in session, not intended for disclosure to building manager, nonetheless disclosed without prior discussion with Client.

What if it was something else? "Client let me know she keyed your car" ..."Client let me know she is smoking weed in the hallway." "Client said [insert ANYTHING here]."

What's the difference?

When you brought this up to the therapist, did you discuss making financial appropriations to pay for the damage? Did you act like you felt really badly and wanted to make things right? If you did, it sounds like the T was just following up on what you asked to do to make things right?

I wonder if you ignored the specific questions posed because if you extend the logic of your position forward, anything said in therapy can be disclosed without client permission if the T feels like he or she is doing the right thing.

To answer your question about the client:

1. Her T confronted her about this damage after he was away for one month.
2. She did not "act like" she felt really bad - she did feel really bad and offered to reimburse him for the cost of repair. She erroneously assumed that the T would arrange for repair without mentioning that a client/she was involved.
3. You are implying that because she wanted to reimburse him, his disclosure doesn't matter - that perhaps she consented implicitly by saying she wished to reimburse him?
4. Why was it necessary for T to involve mention of a client at all in arranging for the repair? It seems irrelevant and as though it unnecessarily puts the frame of the therapy at risk.

Isn't confidentiality normally taken to refer to the issues the client is supposed to be dealing with in therapy? Not an accident that happened that has nothing to do with the client's therapy on the face of it, and which the building manager reasonably could expect restitution for?

It's not like the therapist is revealing the client's secrets. The client's reaction to the therapist's behavior is the issue the therapist needs to deal with, not what the therapist did, unless there is more to the scenario.

Based on what I have learned in my ethics and clinical psych classes.

Breaking a vase accidentally is nothing any client should feel any grief over for more than say, a minute or two. Everyone, including the T, has accidentally broken something more than once. It happens -- no big deal. Hopefully this T has moved on from the accident as well. S/he should in no way be giving the client a hard time about it. Hopefully that is not that case.

Okay, so let's say the accident was caused when the client was very angry about her therapist leaving for a month. The client has a hard time upon return and doesn't talk, the therapist angrily confronts the client about the broken vase (which truly was accidental, and it was a wall - not a vase) and the client admits it and offers to provide reimbursement for the cost of repair.

Who is to decide what is the client's secret in therapy? Isn't the whole point that everything said occurs in a confidential and safe environment? Isn't everything presumed a secret, so that secrets are safe to bring forward?

It's not. But it is troubling for the client to walk in and be told that something she feels very ashamed and guilty about doing was shared with a third party without her knowing that it would be, that the T and this third party spoke about her action and agreed on around what it would cost (rather than waiting for an actual, T gives her an estimate) and T expects her to be grateful for arranging this...

Look...the issue here appears to be the client-therapist relationship and the confrontational manner used by the therapist.

Confidentiality has not been breached. If I told my therapist I was late because I got pulled over for speeding, and she then told her husband, I'd be annoyed, but I wouldn't think she had breached confidentiality.

I think she absolutely would've breached confidentiality in that case. She wouldn't have disclosed your personally identifiable information, but I think its unethical to talk about clients or the content of sessions for no purpose. Period. Your example is actually really clear cut to me.

The issue is the client-therapist relationship, which confidentiality and trust is part of.

Can My Therapist Tell Other People about Our Sessions?

"Confidentiality is one of the cornerstones of therapy. Knowing that you can say anything to your therapist and it will remain in the room helps you feel safe and builds trust between you and the therapist. For this reason, all therapists are legally and ethically bound to keep their sessions confidential and not share with anyone else what was talked about."

..."Ethical therapists NEVER share information about people in therapy casually with friends, family or co-workers."

Your initial question sounded like it dealt with LEGAL confidentiality, and that is what those who responded to you were talking about. Your definition of confidentiality is much broader than the legal one, it's an ethical one. That doesn't mean it's invalid, but you should understand the confusion of those who responded to you. As that website says, law and ethics do not overlap perfectly.

If you're saying that in your view, your therapist breached ETHICAL standards of confidentiality, sure, absolutely - that's your call and yours alone to make, and you obviously have made it.

This whole discussion just seems off to me. If I damaged someone else's property, I would find out who I owed the damages to, buck it up, pay the cost, and move on. The therapist didn't reveal who the client was or any detail. Pay the cost, learn a bit about anger control and the consequences thereof, and move on. You seem to be turning this into an issue that really isn't rather than focusing on the real issue at hand which is your responsibility in the whole scenario. Pay for the damage and move on. I know that may seem really unsympathetic, but you are twisting this all around and trying to find a way to make you therapist guilty for what you did rather than focusing on your responsibility in the matter. I think I'll bow out of this thread now.